SB523, SB514, HB792/SB513, SB516, HB865, Behavioral Health

Joint Committee on Financial Services

The Massachusetts Hospital Association (MHA), on behalf of its member hospitals and health systems, appreciates this opportunity to offer comments related to the bills below.

MHA supports SB523, “An Act establishing accountability for managed care organizations.” This bill would grant important protections to patients harmed by health insurer decisions related to the coverage of certain services or benefits. Health insurance companies frequently make decisions denying approval for the provision of care in a manner that is contrary to the course of treatment recommended by the medical professional actually providing care to the patient. The only recourse for patients or providers is to undertake a lengthy appeals process – one that is regularly ruled in favor of the treating clinician's course of treatment. This appeals process comes at substantial cost to both the patient and provider. Further, patients currently have no recourse when they are harmed as a result of the health insurance company's decision to deny such treatment as the Commonwealth's current consumer protection laws do not specifically address insurer treatment determinations. SB523 would allow those decisions to be reviewed by independent medical experts, who can provide a fair and impartial clinical determination, and grant patients the opportunity to hold a health insurer liable for its actions.”

MHA strongly supports SB514, which requires MassHealth, its contractors and all private insurers to adequately compensate hospitals for the costs of providing interpreter services. The Commonwealth’s interpreter services law (Chapter 66 of the Acts of 2000) required the state to reimburse hospitals for interpreter services related to care provided in emergency departments and behavioral health units. However, the reimbursement level was not set to pay for the interpreter services as a separate service. The provision of appropriate interpreter services is essential to the delivery of timely and medically necessary care. Patients in these settings can simultaneously experience several medical and psychological conditions and the added difficulty of communication burdens on heightens the potential complications that these patients may face. Also, the lack of available medically-certified interpreters who can assist in these settings results in hospitals having to pay higher rates – higher than the national or state average for payment—just to access this important resource. SB514 helps ensure necessary support for this critical element of care by ensuring that hospitals are paid for the actual interpreter service as a separate and distinct service. This important bill will help facilitate the ability of hospitals to best deliver safe and effective care to all patients.

MHA supports HB792/SB513, “An Act relative to ensuring transparency of health plan formularies”. By requiring health insurers to post their drug formularies in an easily accessible and searchable manner, use a standard template to display formulary information and make comparisons among plans easier, include clear information about how deductibles will be applied, and detail applicable quantity limits, step therapy, or prior authorization requirements, HB792/SB513 will reduce confusion and provide consumers with greater transparency around their prescription drug benefits.

MHA supports SB516. This bill proposes important clarifications and updates to the Commonwealth's medical malpractice system. The inefficiencies in the state’s current medical malpractice system have led to increasing costs of professional liability insurance. SB516 would provide for a level of consistency in the system while maintaining a patient's ability to bring a suit on specific cases. Specifically, MHA supports those provisions in SB516 that: 1) promote the development of stable, clear standards for expert witnesses by requiring that an expert witness in an action against a physician be board certified in the same specialty as the defendant physician; 2) increase reporting requirements for liability insurers; 3) allow future sources to be included as evidence of collateral sources; 4) grant the Board of Registration in Medicine authority to review the testimony of expert witnesses from a clinical perspective as to the standard of medical care; 5) allow for periodic payments of awards over $50,000; and 6) ensure that liability is more fairly distributed among all parties, replacing the current system of joint and several liability with the requirement that a defendant be liable only for the amount of damages for which they were responsible. SB516 does not affect a patient’s ability to bring a suit. Instead, this legislation advances important distinctions that would make the malpractice system more fair and reasonable for all parties involved. Physician shortages and continually increasing medical malpractice premiums are strong indicators that the time is ripe for the important changes advanced by this legislation.

MHA opposes HB865, “An Act relative to the indemnification of health professionals.” Contrary to the title, this bill would add administrative requirements and liability on providers who fail to use the Prescription Monitoring Program (PMP). At this time, the state and health care providers are just beginning to work together to establish updated and enhanced access to the PMP. Providers are committed to the use of the PMP and have been meeting with the state to ensure that adequate, correct reporting occurs. However, there are still many unanswered questions and details that need to be resolved related to the state’s outdated PMP system. With such uncertainty remaining, it would be inappropriate to impose the penalties proposed by HB865.

Thank you for the opportunity to offer testimony on these important matters. If you have any questions, or require further information, please contact Michael Sroczynski, MHA’s Vice President of Government Advocacy, at (781) 262-6055 or msroczynski@mhalink.org.